The Laurel Centre has developed a Clinical Statement which outlines the way in which we work with the dual issues of resolving childhood / adolescent sexual abuse and compulsive coping behaviours.
A child who has been sexually abused has been traumatized. This interrupts the normal human developmental process and may result in immediate and longterm effects such as low self esteem, physical/health issues, relationship issues, depression, anxiety and post trauma issues. Women who were sexually abused as children develop numerous ways of coping with the aftermath of trauma. Some of these coping strategies lead to the resolution of the trauma. Other coping strategies enable women to cope with the traumatic environment but do not facilitate resolution and can become problematic in later life.
Addictive / compulsive behaviours (such as alcohol and substance use, shopping, eating, etc.) are common examples of problematic coping strategies. The Laurel Centre recognizes that there is a complex link between addictive / compulsive behaviour and childhood sexual abuse. When the trauma of the abuse is unresolved, therapy provides a context in which healing can occur. Based on an understanding of this client group and trauma resolution theory, The Laurel Centre utilizes a therapeutic intervention involving the following stages: Engaging and Assessing, Creating safety, Intense debriefing, Integrating, and Moving on.
Engaging and Assessing
This stage is about new beginnings. The goals are to establish rapport and to assess the fit between the client's needs and the agency's resources. It is the collaborative process which allows for
a determination of client goals and the negotiation of the therapeutic contract. The roles and boundaries of the therapeutic relationship are established.
This stage also involves the acknowledgment of addiction issues as a coping strategy and the impact of these addictive behaviours on the client and significant others. An assessment of strategies (both formal and informal) to address coping behaviour also occurs. The client is educated about addiction, including the link between addiction and trauma. All of these interventions are important in joining with the client.
I have learned that I am a worthy person, asking for help is ok and there are people around me I can reach out to. Feelings are allowed, I am not to blame for what happened to me.Michelle
The second stage focuses on the issue of safety. Safety in the therapeutic relationship and in the client's life is central to the therapeutic process and are long-term, ongoing issues. The therapist works to develop trust, build the alliance between herself and the client, and create emotional safety in the therapeutic relationship. In order to help the client achieve safety in her life, the therapist and client must address high risk behaviour. This may involve dealing with addictions and helping the client understand how addictive behaviour compromises safety. The client is made aware of the possibility of substituting one addictive behaviour for another healthier behaviour and is helped to identify and utilize appropriate supports for facilitating a change in addictive behaviour. The client is encouraged to develop a range of coping methods. The therapist works with the client to build and strengthen the client's resources (social, psychological, physical, and emotional).
This stage of intervention involves the processing of the childhood sexual abuse and its context. The multiple effects of abuse are addressed. This processing brings a shift in the understanding
of the meaning of the abuse and helps the client begin to define self. There is a linking of past experiences and messages with present behaviours, beliefs, and responses. The client is assisted in recognizing her personal power. She is supported in grieving the losses associated with childhood sexual abuse and is helped to let go of thoughts about the way things "should" have been. During this stage the client is also encouraged to talk about losses that have occurred as a result of the addiction and is helped to deal with the grief over the emotional loss of this addictive behaviour. The flood of emotion resulting from no longer suppressing emotion with addictive behaviour is normalized. Relapse potential of addictive behaviour is monitored and healthier resources / skills / supports are reinforced.
This stage involves working towards putting Change into action. Changes made earlier in the therapeutic process are strengthened. The client is helped to begin to develop positive future goals with realistic expectations. She is assisted in framing her experiences within a broader social context (social, economic, political, etc.) To assist in managing the addictive
behaviour, new coping skills are practiced and reinforced. The client is helped to develop a heightened self awareness and deeper understanding of past patterns which better enables her to access new skills.
This stage facilitates a shift in priorities so that the abuse is no longer the central feature of the client's identity. The client's accomplishments are celebrated and the client is supported to make desired changes in goals, roles, career and / or lifestyle. During this phase, the client's independence is encouraged and there is a gradual de-emphasizing of the therapist's role. The client is encouraged to develop self as a primary resource to continue her healing. She is also encouraged to increase her use of informal social supports and resources. This stage involves closure of the therapeutic relationship and involves recognizing and processing the loss of this relationship. The client is encouraged to self-monitor behaviours / thoughts / emotional states that may indicate increased risk of returning to previous addictive behaviour.